HEART VALVE REPLACEMENT

INDICATIONS

• Severe Valvular Stenosis (narrowing)

• Regurgitation/Incompetence (backflow)

• (causing symptomatic heart failure, angina, or syncope.)

TYPES OF VALVES

MECHANICAL

BIOPROSTHETIC

DIFFERENCE BETWEEN VALVE TYPES

MECHANICAL

• LIFELONG WARFARIN THERAPY

• 2 YEARS

• CLICKING SOUND

BIOPROSTHETIC

• 10-15 YEARS

• TEMPORARY WARFARIN 3 MONTHS

PERIOPERATIVE NURSING CARE

DENTAL CLEARANCE

• clear any infections or caries prior to surgery

• Oral bacteria entering the bloodstream during surgery can colonize the new valve, causing fatal Infective Endocarditis

BASELINE DIAGNOSTICS

• Obtain 12-lead ECG

• Chest X-ray

• Echocardiogram (measures ejection fraction and valve gradient)

• CBC, CMP, Blood Cultures

• Coagulation panel (PT/INR, PTT), and crossmatch.

SKIN PREP

• dual chlorhexidine baths

• administer prohyplactic IV antibiotics ( cefazolin, vancomycin) 60 MIN BEFORE INCISION

PATIENT AND FAAMILTY EDUCAITON

PX AND FAMILY EDUCATION

• Teach post-op sternal precautions

• coughing/deep breathing with sternal splinting

• explain the need for lifelong antibiotic prophylaxis before future invasive procedures.

POST OP NURSING CARE

HEMODYNAMIC STATBILITY

• monitorl arterial line BP CVP

• MAP 65-85 mmHg

BLEEDING IN CHEST TUBE DRAINAGE

• REPORT DRAINAGE

• GREATER THAN 150 mL/HR

• sudden cessation of drainage accompanied by signs of caaardiac tamponade

AUSCULATION OF VALVE SOUNDS

• NEW MURMUR OF LOSS PF CLICKONG SOUND

VENTILATOR WEANING AND PULMONARY CARE

• 6-12 HOURS IF TABLE

• ENCOURAGE NCIETIVE SPIROMETRY`

CRITICAL NURSING RESPONSIBILITIES AND MONITORING

INFECITVE ENDOCARDITIS MONITORING

• MONITOR FOR LOW GRADE FEVER

• ELEVATED WBC

• OSLER’S NODES

• JANEWAY LESIONS

THOMBOEMBOLISM AND STROKE

• NEURO ASSESMENT GCS AND NIHS

• WOFO SUDDEN VISUAL CHANGE, SLURRED SPEECH BASTA STOKE SIGNS

• CUZ OF MICROEMBOLI FROM NEW VALVE

POSTOPERATIVE DRYRHYTHMIAS

• MONIRRTOR FOR AFIB OR HEART BLOCK

  • ESP AT AORTIC VALVE SINCE CLOSER TO AV NODE

  • 
    

MEDS TO HOLD

ORAL ANTICOAGS

ANTIPLATELET

ACE INHIBITORS AND ARBS

• hold 24 hours prior

• Prevents severe, refractory hypotension during CPB pump weaning.

ANTIDIABETICS

• HOLD 48 HOURS

• RISK OF LACTIC ACIDOSIS

• ACUTE RENAL STRAIN

MEDICATIONS TO GIVE

ANTICOAGS - POST OP

ANTIBIOTICS PRE AND POST

INOTROPES

• Supports cardiac output and maintains MAP >65\text{ mmHg}.

• IV post op in ICU

• dobutamine norepi

BETAA BLOCKERS

• post op day 1

• Reduces myocardial oxygen demand and prevents Post-Op AFib.

ANTIBIOTIC

• amoxicilkin

• GIVEN BEFORE ALL FUTURE DENTAL OR INVASIVE

• Mandatory lifelong teaching to prevent Infective Endocarditis.